Home Monitoring of Patients Hits Radar Screens of Health Insurers
Some of the health plans that considered paying for remote monitoring of congestive heart failure patients at home 10 years ago are finally starting to do so in hope of averting costly hospital readmissions. The question -- and the pity -- is why they didn't do this before.
Anthem Blue Cross of California, a unit of WellPoint, is piloting a wireless scale and a wireless blood pressure cuff that can communicate via the Internet with nurse case managers. Aetna is cosponsoring a clinical trial with Intel-a tireless advocate of home monitoring devices that can use its chips-to find out whether remote monitoring cuts down on unnecessary hospitalizations of heart failure patients. Humana plans to launch a program using wireless devices in January, and United Healthcare is using a wireless scale that can ask patients questions about their self-care and forward their answers to care managers. Both United and WellPoint are also experimenting with video chats between patients and nurses.
What's amazing about all of this activity is that -- with the exception of the webcams -- disease management vendors were using these techniques a decade ago.
For example, a disease management firm named LifeMasters had heart failure patients using the Internet to transmit data from monitoring devices and to receive messages about their self-care. Another company, Health Hero Network, asked to patients to answer personalized questions daily on a Web-connected device called a Health Buddy. They also received information and messages tailored to their needs. These technologies cut the cost of disease management by about 35 percent at the time. And some studies showed that they also prevented readmissions.
The health insurers weren't totally deaf, dumb, and blind. PacifiCare's Secure Horizons unit, a Medicare Advantage plan, used the Alere system, which asked automated questions and collected readings from a digital scale, in four states. And Humana worked with CorSolutions, another disease management vendor, on a monitoring system for several conditions that use a Palm Pilot (remember those?) to upload biometric data.
So why didn't the plans take the ball and run with it? First, it's important to remember that heart failure is the low-hanging fruit in terms of quick return on investment in remote monitoring. Since heart failure is mainly a condition of the elderly, Medicare Advantage plans reap the main benefits from home monitoring of these patients. So perhaps the insurance companies didn't see it as advantageous to their commercial plans.
Another factor was the evolution of disease management. While health plans hired some disease management vendors that used home monitoring, the technology became increasingly difficult to sustain as the plans forced the vendors to share their profits with them. In addition, disease management itself has lost much of its luster, having failed to deliver most of its promised cost savings.
Meanwhile, however, the VA system and Kaiser Permanente -- the two largest integrated delivery systems in the country -- both realized substantial savings from home monitoring, and the VA documented those gains in a series of papers. It's apparently this evidence, along with other research, that finally persuaded some insurers to try remote monitoring on their own. They may have also been influenced by evidence showing that 40 percent of heart failure patients are readmitted within six months, at a staggering cost.
In any case, it's good that the health plans have finally seen the light. If they really support remote monitoring of heart failure patients and extend it to other conditions, it will benefit both patients and providers, including the hospitals that will be dinged for preventable readmissions under the Affordable Care Act. Let's hope that this is not just another passing fad.
Image supplied courtesy of Wikimedia Commons.
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